Forum for Health Economics and Policy最新文献

{"title":"The Option Value of Innovative Treatments for Metastatic Melanoma.","authors":"Julia Thornton Snider,&nbsp;Seth Seabury,&nbsp;Mahlet Gizaw Tebeka,&nbsp;Yanyu Wu,&nbsp;Katharine Batt","doi":"10.1515/fhep-2016-0014","DOIUrl":"https://doi.org/10.1515/fhep-2016-0014","url":null,"abstract":"<p><p>Background Treatment options in oncology have increased in recent years due to the quick pace of innovation. In the cancer care landscape, therapies that enable patients to live to the next innovation have additional value, \"option value,\" from the benefit of surviving to the next innovation. In such disease areas, providers and payers should consider this value when gauging the value of new therapies. The purpose of this study is to develop a model to estimate the additional survival patients attain from a therapy that allows them to live to benefit from further advances in care, and to apply the model to immunotherapy for metastatic melanoma. Methods The benefit of a therapy extends beyond immediate tumor control; it can also allow patients to live to benefit from further advances in care. This is a therapy's option value. Using data from the SEER cancer registry and clinical trial publications, we developed a model to estimate option value and applied it to ipilimumab, the first immune checkpoint modulator used to treat metastatic melanoma. Because ipilimumab extends survival, select patients benefited from survival extension to live to benefit from the introduction of PD-1 inhibitors (i.e. pembrolizumab and nivolumab). We calculated the option value of ipilimumab in terms of additional life-months patients gained by living to become potential candidates for PD-1 inhibitors, discounting at 3% per year. Results Patients taking ipilimumab as a second-line therapy for metastatic melanoma gained 10.5 months compared to patients taking the prior standard of care. Patients diagnosed in 2011, 2012, and 2013 gained an additional 1.6, 2.8, and 5.1 months of life expectancy, respectively, by living to see the introduction of PD-1 inhibitors. This equates to an option value of 15%, 27%, and 49%, respectively, of the conventionally calculated survival gain from ipilimumab. Ipilimumab had greater option value for patients diagnosed in later years who were more likely to live to the introduction of PD-1 inhibitors. Conclusions Therapies that enable patients to see further advances in care have option value. Option value is particularly important to patients with disease areas undergoing rapid innovation.</p>","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1515/fhep-2016-0014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36484760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Price Elasticity of Specialty Drug Use: Evidence from Cancer Patients in Medicare Part D.","authors":"Jeah Kyoungrae Jung, Roger Feldman, A Marshall McBean","doi":"10.1515/fhep-2016-0007","DOIUrl":"10.1515/fhep-2016-0007","url":null,"abstract":"<p><p>Specialty drugs can bring substantial benefits to patients with debilitating conditions, such as cancer, but their costs are very high. Insurers/payers have increased patient cost-sharing for specialty drugs to manage specialty drug spending. We utilized Medicare Part D plan formulary data to create the <i>initial price</i> (cost-sharing in the initial coverage phase in Part D), and estimated the total demand (both on- and off-label uses) for specialty cancer drugs among elderly Medicare Part D enrollees with no low-income subsidies (non-LIS) as a function of the initial price. We corrected for potential endogeneity associated with plan choice by instrumenting the initial price of specialty cancer drugs with the initial prices of specialty drugs in unrelated classes. We report three findings. First, we found that elderly non-LIS beneficiaries with cancer were less likely to use a Part D specialty cancer drug when the initial price was high: the overall price elasticity of specialty cancer drug spending ranged between -0.72 and -0.75. Second, the price effect in Part D specialty cancer drug use was not significant among newly diagnosed patients. Finally, we found that use of Part B-covered cancer drugs was not responsive to the Part D specialty cancer drug price. As the demand for costly specialty drugs grows, it will be important to identify clinical circumstances where specialty drugs can be valuable and ensure access to high-value treatments.</p>","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"20 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877476/pdf/nihms927080.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35970089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disability Measurement in the Health and Retirement Study.","authors":"Emily M Agree,&nbsp;Douglas A Wolf","doi":"10.1515/fhep-2017-0029","DOIUrl":"https://doi.org/10.1515/fhep-2017-0029","url":null,"abstract":"<p><p>The Health and Retirement Study (HRS) has provided extensive and detailed national data on disability since it began in 1992, and has been used extensively in studies of disability trends and trajectories. We summarize conceptual frameworks used to characterize disability and review the HRS measures of functioning, work disability, and employer accommodations. HRS survey questions have experienced changes in wording, skip logic, or other design features over the life of the study, and we comment on the analytic challenges posed by those changes. Among our conclusions are (1) work disability and benefit eligibility are important concepts that should be considered for redesign to better reflect current concepts and policy issues; (2) methodological studies of changes in wording or skip logic should be undertaken; and (3) minor additions to survey content in areas such as temporal reference periods or changes in social-participation activities would improve measurement.</p>","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1515/fhep-2017-0029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36484762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Value of the Health and Retirement Study for Health Economics Research.","authors":"Courtney C Coile,&nbsp;Nicole Maestas","doi":"10.1515/fhep-2017-0028","DOIUrl":"https://doi.org/10.1515/fhep-2017-0028","url":null,"abstract":"<p><p>We assess the value of the Health and Retirement Study (HRS) for research in health economics by conducting a survey of leading health economists. We analyze the survey responses to provide an assessment of the strengths of the HRS for this kind of research, as well as the obstacles that prevent it from being used more widely. We offer some suggestions as to how these obstacles might be overcome through changes to the survey and actions to increase survey awareness and access.</p>","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1515/fhep-2017-0028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36484761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Accuracy of Economic Measurement in the Health and Retirement Study","authors":"Eric French, J. Jones, J. McCauley","doi":"10.1515/fhep-2017-0001","DOIUrl":"https://doi.org/10.1515/fhep-2017-0001","url":null,"abstract":"Abstract We assess the quality of the HRS’s measures of out-of-pocket medical spending and health insurance premia, both in the “core interviews” and in the “exit interview” data. We provide detailed evidence on the quality of the HRS insurance premia data, and we compare the HRS exit data to exit data in the MCBS. We document how changes in survey questions, including the introduction of “unfolding brackets,” affect the HRS measures. We document what we believe are errors in the HRS imputations and provide some suggestions for improving the accuracy of some imputed variables. Overall, we find the HRS data to be of high quality. However, we believe that many interesting variables in the HRS are under-utilized because users must perform imputations themselves.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75202360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using the Health and Retirement Study for Disability Policy Research: A Review","authors":"Jody Schimmel Hyde, D. Stapleton","doi":"10.1515/fhep-2017-0002","DOIUrl":"https://doi.org/10.1515/fhep-2017-0002","url":null,"abstract":"Abstract The Health and Retirement Study (HRS) is a preeminent data source for research related to the experiences of workers nearing retirement, including the large share of those workers who experience a health shock or disability onset after age 50. In this article, we highlight key information collected from HRS respondents that benefits disability policy research and the body of knowledge that has resulted from this information. Our main goal is to identify from this research experience potential improvements in data collection and documentation that would further strengthen the HRS as a data source for disability policy researchers.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85369773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Pharmaceutical Innovation on Cancer Mortality in Belgium, 2004–2012","authors":"F. Lichtenberg","doi":"10.1515/fhep-2015-0042","DOIUrl":"https://doi.org/10.1515/fhep-2015-0042","url":null,"abstract":"Abstract Cancer mortality declined in Belgium during the period 2004–2012, but there was considerable variation in the rate of decline across cancer sites (breast, lung, etc.). I analyze the effect that pharmaceutical innovation had on cancer mortality in Belgium, by investigating whether the cancer sites that experienced more pharmaceutical innovation had larger subsequent declines in mortality, controlling for changes in cancer incidence. The measures of mortality analyzed – premature (before ages 75 and 65) mortality rates and mean age at death – are not subject to lead-time bias. Premature cancer mortality rates are significantly inversely related to the cumulative number of drugs registered 15–23 years earlier. Since mean utilization of drugs that have been marketed for less than 10 years is less than one fourth as great as mean utilization of drugs that have been marketed for at least a decade, it is not surprising that premature mortality is strongly inversely related only to the cumulative number of drugs that had been registered at least 10 years earlier. Drugs registered during the period 1987–1995 are estimated to have reduced the premature cancer mortality rate in 2012 by 20%. Mean age at death from cancer increased by 1.17 years between 2004 and 2012. The estimates indicate that drugs registered during the period 1987–1995 increased mean age at death from cancer in 2012 by 1.52 years. The estimates also suggest that drugs (chemical substances) within the same class (chemical subgroup) are not “therapeutically equivalent,” i.e. they do not have essentially the same effect in the treatment of a disease or condition. The estimates imply that the drugs registered during 1987–1995 reduced the number of life-years lost to cancer at all ages in 2012 by 41,207. The estimated cost per-life-year gained in 2012 from cancer drugs registered in Belgium during the period 1987–1995 was €1311. This estimate is well below even the lowest estimates from other studies of the value of a life-year saved. The largest reductions in premature mortality occur 15–23 years after drugs are registered, when their utilization increases significantly. This suggests that, if Belgium is to obtain substantial additional reductions in premature cancer mortality in the future (15 or more years from now) at a modest cost, pharmaceutical innovation (registration of new drugs) is needed today.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"193 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73759537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Share Price Effect of CVS Health’s Announcement to Stop Selling Tobacco: A Comparative Case Study Using Synthetic Controls","authors":"M. Andersen, Sebastian Bauhoff","doi":"10.1515/fhep-2015-0045","DOIUrl":"https://doi.org/10.1515/fhep-2015-0045","url":null,"abstract":"Abstract We study how the announcement by CVS Health, a large US-based pharmacy chain, to stop selling tobacco products affected its share price and that of its close competitors, as well as major tobacco companies. Combining event study and synthetic control methodologies we compare measures of CVS’s stock market valuation with those of a peer group consisting of large publicly listed firms that are part of Standard & Poor’s S&P 500 stock market index. CVS’s announcement is associated with a short-term decrease in its share price, whereas close competitors have benefitted from CVS’ decision. We also find a negative share price effect for Altria, the largest US domestic tobacco firm. Overall our findings are consistent with markets expecting consumers to shift from CVS to alternative outlets in the short-run, and interpreting CVS’ decision to drop tobacco products as signal that other firms may follow suit.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86380806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of the Health Insurance Mandate on Labor Market Activity and Time Allocation: Evidence from the Federal Dependent Coverage Provision","authors":"Otto Lenhart, Vinish Shrestha","doi":"10.1515/fhep-2016-0006","DOIUrl":"https://doi.org/10.1515/fhep-2016-0006","url":null,"abstract":"Abstract The primary goal of the federal dependent coverage mandate was to increase health insurance coverage among young adults, the group with the lowest prevalence of health insurance coverage. To understand the full impacts of the federal dependent coverage mandate, it is important to evaluate how the mandate affects labor market activities and time spent away from work among young adults. Using data from the Consumer Population Survey (CPS) and the American Time Use Survey (ATUS) and implementing a difference-in-differences framework, we find: (1) Young adults substitute employer sponsored insurance for dependent coverage, (2) Affected individuals reduce their work time and switch from full- to part-time employment, and (3) The additional time from reduced labor market activity is reallocated towards more time spent on leisure activities, mainly watching television. The effects of the mandate on labor market activities are stronger in later years. Furthermore, we show that young adults do not increase the time they spend on activities that could enhance their human capital such as education and health, which reemphasizes potential unintended consequences of the mandate. These findings suggest that future work is necessary to fully understand the overall welfare effects of the policy.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"78 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89416904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Long-Term Impact of Price Controls in Medicare Part D","authors":"Gigi Moreno, E. van Eijndhoven, J. Benner, J. Sullivan","doi":"10.1515/fhep-2016-0011","DOIUrl":"https://doi.org/10.1515/fhep-2016-0011","url":null,"abstract":"Abstract Price controls for prescription drugs are once again at the forefront of policy discussions in the United States. Much of the focus has been on the potential short-term savings – in terms of lower spending – although evidence suggests price controls can dampen innovation and adversely affect long-term population health. This paper applies the Health Economics Medical Innovation Simulation, a microsimulation of older Americans, to estimate the long-term impacts of government price setting in Medicare Part D, using pricing in the Federal Veterans Health Administration program as a proxy. We find that VA-style pricing policies would save between $0.1 trillion and $0.3 trillion (US$2015) in lifetime drug spending for people born in 1949–2005. However, such savings come with social costs. After accounting for innovation spillovers, we find that price setting in Part D reduces the number of new drug introductions by as much as 25% relative to the status quo. As a result, life expectancy for the cohort born in 1991–1995 is reduced by almost 2 years relative to the status quo. Overall, we find that price controls would reduce lifetime welfare by $5.7 to $13.3 trillion (US$2015) for the US population born in 1949–2005.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85609621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}